在一项为期 42 个月的处方类阿片依赖治疗后自然随访研究中，阿片类药物戒断的相关因素。
Correlates of Opioid Abstinence in a 42-Month Posttreatment Naturalistic Follow-Up Study of Prescription Opioid Dependence.
机构信息
McLean Hospital, 115 Mill St, Belmont, MA 02478.
Division of Alcohol and Drug Abuse, McLean Hospital, Belmont, Massachusetts, USA.
出版信息
J Clin Psychiatry. 2019 Mar 26;80(2):18m12292. doi: 10.4088/JCP.18m12292.
OBJECTIVE
The natural course of prescription opioid use disorder has not been examined in longitudinal studies. The current study examined correlates of opioid abstinence over time after completion of a treatment trial for prescription opioid dependence.
METHODS
The multisite Prescription Opioid Addiction Treatment Study examined different durations of buprenorphine-naloxone treatment and different intensities of counseling to treat prescription opioid dependence, as assessed by DSM-IV; following the clinical trial, a longitudinal study was conducted from March 2009-January 2013. At 18, 30, and 42 months after treatment entry, telephone interviews were conducted (N = 375). In this exploratory, naturalistic study, logistic regression analyses examined the association between treatment modality (including formal treatment and mutual help) and opioid abstinence rates at the follow-up assessments.
RESULTS
At the 3 follow-up assessments, approximately half of the participants reported engaging in current substance use disorder treatment (47%-50%). The most common treatments were buprenorphine maintenance (27%-35%) and mutual-help group attendance (27%-30%), followed by outpatient counseling (18%-23%) and methadone maintenance (4%). In adjusted analyses, current opioid agonist treatment showed the strongest association with current opioid abstinence (odds ratios [ORs] = 5.4, 4.6, and 2.8 at the 3 assessments), followed by current mutual-help attendance (ORs = 2.2, 2.7, and 1.9); current outpatient counseling was not significantly associated with abstinence in the adjusted models.
CONCLUSIONS
While opioid agonist treatment was most strongly associated with opioid abstinence among patients with prescription opioid dependence over time, mutual-help group attendance was independently associated with opioid abstinence. Clinicians should consider recommending both of these interventions to patients with opioid use disorder.
TRIAL REGISTRATION
ClinicalTrials.gov identifier: NCT00316277.
目的
在纵向研究中尚未研究处方类阿片使用障碍的自然病程。本研究在完成处方类阿片依赖治疗试验后，考察了不同时间点阿片类物质戒断的相关因素。
方法
多地点处方类阿片成瘾治疗研究采用不同持续时间的丁丙诺啡-纳洛酮治疗和不同强度的咨询治疗方案，评估方法为 DSM-IV；临床试验结束后，从 2009 年 3 月至 2013 年 1 月进行了纵向研究。在治疗开始后 18、30 和 42 个月进行了电话访谈（N=375）。在这项探索性、自然主义研究中，逻辑回归分析考察了治疗方式（包括正式治疗和互助）与随访评估时阿片类物质戒断率之间的关联。
结果
在 3 次随访评估中，约有一半的参与者报告正在接受当前的物质使用障碍治疗（47%-50%）。最常见的治疗方法是丁丙诺啡维持治疗（27%-35%）和互助小组参加（27%-30%），其次是门诊咨询（18%-23%）和美沙酮维持治疗（4%）。在调整分析中，当前阿片类激动剂治疗与当前阿片类物质戒断的关联最强（3 次评估的优势比[OR]分别为 5.4、4.6 和 2.8），其次是当前互助小组参加（OR 分别为 2.2、2.7 和 1.9）；当前门诊咨询在调整模型中与戒断无显著关联。
结论
尽管在时间上，阿片类激动剂治疗与处方类阿片依赖患者的阿片类物质戒断最密切相关，但互助小组参加与阿片类物质戒断独立相关。临床医生应该考虑向阿片类物质使用障碍患者推荐这两种干预措施。
试验注册
ClinicalTrials.gov 标识符：NCT00316277。
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